Merrick Blair, Sergaki Chrysi, Edwards Lindsey, Moyes David L, Kertanegara Michael, Prossomariti Désirée, Shawcross Debbie L, Goldenberg Simon D
Centre for Clinical Infection and Diagnostics Research, Guy's and St Thomas' NHS Foundation Trust, King's College, London SE1 7EH, UK.
Diagnostics R&D, Medicines and Healthcare Products Regulatory Agency (MHRA), Potters Bar EN6 3QG, UK.
Infect Dis Rep. 2023 May 9;15(3):238-254. doi: 10.3390/idr15030025.
Antimicrobial resistance (AMR) is one of the greatest challenges facing humanity, causing a substantial burden to the global healthcare system. AMR in Gram-negative organisms is particularly concerning due to a dramatic rise in infections caused by extended-spectrum beta-lactamase and carbapenemase-producing Enterobacterales (ESBL and CPE). These pathogens have limited treatment options and are associated with poor clinical outcomes, including high mortality rates. The microbiota of the gastrointestinal tract acts as a major reservoir of antibiotic resistance genes (the resistome), and the environment facilitates intra and inter-species transfer of mobile genetic elements carrying these resistance genes. As colonisation often precedes infection, strategies to manipulate the resistome to limit endogenous infections with AMR organisms, as well as prevent transmission to others, is a worthwhile pursuit. This narrative review presents existing evidence on how manipulation of the gut microbiota can be exploited to therapeutically restore colonisation resistance using a number of methods, including diet, probiotics, bacteriophages and faecal microbiota transplantation (FMT).
抗菌药物耐药性（AMR）是人类面临的最大挑战之一，给全球医疗保健系统带来了沉重负担。革兰氏阴性菌中的AMR尤其令人担忧，因为产超广谱β-内酰胺酶和碳青霉烯酶的肠杆菌科细菌（ESBL和CPE）引起的感染急剧增加。这些病原体的治疗选择有限，并且与包括高死亡率在内的不良临床结果相关。胃肠道微生物群是抗生素耐药基因（耐药基因组）的主要储存库，环境促进携带这些耐药基因的移动遗传元件在种内和种间转移。由于定植通常先于感染，因此操纵耐药基因组以限制AMR生物体的内源性感染以及防止传播给他人的策略是一项值得追求的目标。这篇叙述性综述介绍了现有证据，说明如何利用多种方法（包括饮食、益生菌、噬菌体和粪便微生物群移植（FMT））来操纵肠道微生物群，以治疗性地恢复定植抗性。
